New York Drug and Alcohol Inpatient Treatment Licensing

Author: A. Ant, CADC-II, Licensing & Accreditation Expert

Disclaimer: This content is provided for general informational purposes only and should not be construed as legal, regulatory, or licensing advice. Requirements change frequently. Consult qualified professionals for guidance specific to your situation.

Apply now: OASAS Program Certification | Questions: Certification@oasas.ny.gov, OASAS Certification line (518) 485-2250

Bedded addiction treatment in New York is certified by the Office of Addiction Services and Supports (OASAS), and the rule you apply under depends on the service. Part 818 covers inpatient rehabilitation for adults. Part 820 covers residential services, built from stabilization, rehabilitation and reintegration elements. Withdrawal and stabilization services sit in Part 816. The old Part 819 residential rule stopped having effect after February 28, 2026, so any new residential program today is a Part 820 program. Whichever one fits, getting there means clearing a prior approval process that most operators from other states don’t expect.

None of these OASAS rules uses ASAM level numbers. OASAS places patients with its own level of care protocol, so deciding which ASAM level a Part 818 unit or a Part 820 element most resembles is our judgment call, not something the state prints on your operating certificate. If payers or out-of-state referral partners want an ASAM label they can check, CARF’s ASAM Level of Care Certification is a separate credential, run with ASAM, that currently covers adult residential Levels 3.1, 3.5 and 3.7. Anyone can confirm a program holds it by filtering CARF’s provider search for “ASAM Level of Care 3.7” (or 3.1, 3.5). Because CARF and ASAM aim it at residential treatment levels, it can’t take the place of the OASAS Part 816 operating certificate a withdrawal program needs.

OASAS Prior Approval Comes Before Anything Else

This step comes before almost everything else in the New York process, and skipping ahead of it is a common, costly mistake. Before you establish, incorporate, or construct a residential facility, OASAS requires the commissioner’s prior approval under 14 NYCRR Part 810. This starts with a Prior Consultation with your OASAS Regional Office and the Local Governmental Unit (LGU) in the county where you’re proposing services, followed in most cases by a Prior Consultation form signed by both. OASAS says you submit that signed form with your application, not separately, and only once you’ve had a recommendation to move forward. In the projects we’ve seen, rushing this step is the usual reason New York residential applications stall for months.

Deemed Status Doesn’t Reach Standard Residential Programs

This benefit sounds broader than it actually is once you read the statute closely. Mental Hygiene Law § 32.14 only reaches general hospitals (Article 28 of the Public Health Law) holding an OASAS operating certificate and accredited by The Joint Commission or another accreditor with CMS deeming authority. In practice, OASAS’s deeming initiative accepts Joint Commission surveys for hospital-based Part 822 outpatient programs and opioid treatment programs. A freestanding Part 818 or Part 820 program is outside both, and CARF isn’t named in the statute at all. Joint Commission or CARF accreditation still helps with referral sources and payers, but it won’t reduce OASAS’s own inspections of a freestanding program.

Medication-Assisted Treatment in a Residential Setting

Parts 818 and 820 reach full opioid agonist medication, methadone included, through a partner opioid treatment program rather than through your own certificate, and OTPs carry their own requirements, including approval from a federally approved accrediting body under 14 NYCRR 822.3. Both rules spell out what that means for you: the program must have a formal agreement with at least one OASAS-certified OTP so residents can get full opioid agonist medication, must keep patients on their approved medication when clinically appropriate and the patient consents, and must provide FDA-approved addiction medications to current patients and to people seeking admission. Buprenorphine is easier to arrange on site, since DEA confirmed in January 2023 that buprenorphine prescriptions “only require a standard DEA registration number.” Write the OTP agreement and your medication policy around the actual partner and prescriber you’ll use, because a vague promise to refer out won’t match what Parts 818 and 820 require.

Ketamine Inside an OASAS Inpatient or Residential Program

OASAS rules don’t mention ketamine. This section applies Parts 800, 810 and 818 and federal drug law to it, which makes the conclusions our interpretation. Get your Regional Office’s view before acting on them.

Part 800 is the place to start, mostly for what it leaves out. Its medication access duties are built around “approved medication,” defined in § 800.4(c) as medication approved by state and federal authorities for treating substance use disorder. Ketamine has no FDA approval for any substance use disorder, so it never becomes part of the medication access a Part 818 or Part 820 program owes patients under § 800.6, and offering it is a separate clinical decision. One Part 800 duty does follow it in: a program that dispenses medication has to build a diversion control plan into its quality improvement plan (§ 800.6(e)).

Part 818 inpatient rehabilitation has the staff to consider it. Section 818.7 puts the medical director in charge of medical policies, requires at least one full-time registered nurse plus LPNs “available to all patients at all times,” and, for patients with co-existing medical or psychiatric conditions, calls for an appropriately qualified physician, physician assistant, nurse practitioner, psychiatrist or psychologist on site or through telepractice. A patient with treatment-resistant depression alongside an alcohol use disorder is exactly that patient. We’d be more cautious about dosing in a Part 820 residential element and would raise it with OASAS before trying.

Prior approval is the open question. Section 810.1 requires the commissioner’s prior approval before a provider offers a service, and nothing we read says whether a ketamine protocol inside an already certified inpatient service counts as a new one. Ask before the first dose, not after a survey asks you.

The Drug Rules That Apply on the Unit

Ketamine is a Schedule III controlled substance (21 CFR 1308.13(c)(7)), and every location that stores or administers it needs its own DEA registration under 21 CFR 1301.12. New York’s I-STOP law, Public Health Law § 3343-a, requires a practitioner to consult the prescription monitoring registry before prescribing or dispensing a Schedule II, III or IV drug, but it excludes a practitioner administering a controlled substance and one ordering it for use on the premises of an institutional dispenser. Doses given on the unit don’t trigger a lookup; a take-home prescription at discharge does. We found no guidance from the State Education Department or the Board for Nursing on registered nurses giving ketamine, so the program’s nursing policies have to carry that. Esketamine (Spravato) can be used only in a healthcare setting certified in its REMS, and its FDA labeling requires monitoring for at least 2 hours after each dose.

Who Continues the Series After Discharge

Supervised days on an inpatient unit are a sensible start, but the series usually continues at an outpatient ketamine practice, and New York is strict about who owns one. Business Corporation Law § 1507 lets a professional service corporation issue shares “only to individuals who are authorized by law to practice in this state,” and in State Farm v. Mallela (2005) the Court of Appeals said New York’s licensing requirements “prohibit nonphysicians from owning or controlling medical service corporations.” So the practice is physician-owned, often with a management services company handling the business side. The fee and naming rules for that setup are in the ketamine section of New York Drug and Alcohol Outpatient Treatment Licensing. Referrals between your program and an affiliated practice carry two risks: Education Law § 6530(18) makes it professional misconduct to give or receive a fee “for the referral of a patient,” and the federal Eliminating Kickbacks in Recovery Act (18 U.S.C. § 220) reaches payment for referrals to SUD treatment facilities. Have counsel review any money that moves between them.

Staffing a Residential Program

New York’s CASAC credentialing tiers are the real lever operators have on residential payroll. The two rules set different floors. A Part 818 inpatient program needs a program director who is a qualified health professional with three years of SUD services experience and two more years in a supervisory role, a medical director, at least one full-time registered nurse with enough added LPNs, RNs, physician assistants or nurse practitioners to cover the services, and a clinical staff that is at least 50 percent qualified health professionals (CASAC-Trainees can count toward that half). Part 820 stabilization and rehabilitation elements need a clinical supervisor who is a qualified health professional with three years of SUD treatment experience, at least one CASAC available at all times, and an RN and an LPN on site daily. New York’s full CASAC credential requires 6,000 hours of supervised work experience, roughly three years, along with 350 clock hours of education and passing an OASAS-approved exam.

Round-the-clock coverage adds real cost. A residential program with a clinical director, several counselors, and 24-hour direct-care staff commonly runs well past $500,000 a year in payroll before nursing coverage is factored in, given New York’s counselors earn a median of $59,450 statewide. New York’s CASAC pathway gives operators a practical way to bring that down. Many programs we work with fill a share of counseling roles with CASAC-Trainees building their supervised hours under fully credentialed staff, which Part 818 expressly allows toward its 50 percent rule, and they build medical coverage around the required RN with LPNs filling out the schedule rather than putting a registered nurse on every shift. CASAC-Provisional holders can also work in OASAS-certified settings, but check how your rule counts them before you build a staffing plan around them. That specific staffing matrix comes together once census and level of care are confirmed.

How to Submit Your OASAS Application

Start with Prior Consultation through your OASAS Regional Office and the Local Governmental Unit in your county. Once you have the go-ahead, the Part 818 or Part 820 application is uploaded through the state’s NYSE-CON system using a Health Commerce System or NY.gov account, as OASAS’s Program Certification page explains. It is not emailed. Questions and NYSE-CON submission problems go to the Bureau of Certification at Certification@oasas.ny.gov, OASAS’s contact page lists (518) 485-2250 as its Certification number, and OASAS’s main office is at 1450 Western Avenue, Albany, NY 12203-3526, (518) 473-3460. Your Regional Office is the place to confirm which forms and attachments your particular project needs before you file.

What Delays New York Residential Applications

Leaving aside the Part 810 wait itself, two problems account for most of the residential delays we see. The most common is underestimating the Local Governmental Unit’s role and timeline. OASAS wants the LGU in the very first proposal discussion, its signature on the Prior Consultation form, and in most cases its prior approval, so it is involved from the start rather than signing off at the end. The second common issue is assuming accreditation buys a deemed-status benefit that, for freestanding residential programs, simply doesn’t exist under current rules.

Frequently Asked Questions

Lining up OASAS prior approval and your Local Governmental Unit for a New York residential program? Reach out here.

Sources

• OASAS, Part 818: Substance Use Disorder Inpatient Services (Part 818) (checked October 7, 2026)
• 14 NYCRR 818.2 and 818.7 (official text via Justia mirror): Part 818 general service standards and staffing (checked October 7, 2026)
• OASAS, Part 820: Residential Services (Part 820) and Part 820 rule text (checked October 7, 2026)
• OASAS, Part 819 sunset: Notice of Adoption, Part 819 (checked October 7, 2026)
• 14 NYCRR 816.1 (Justia mirror): Withdrawal and stabilization services (checked October 7, 2026)
• 14 NYCRR 822.3 (Justia mirror): Outpatient applicability and OTP accreditation (checked October 7, 2026)
• 14 NYCRR 810.1 (Justia mirror): Prior approval requirement (checked October 7, 2026)
• OASAS: Program Certification (checked October 7, 2026)
• OASAS: Contact Us (checked October 7, 2026)
• NY Mental Hygiene Law § 32.14: Compliance with operational standards by providers of services in general hospitals (checked October 7, 2026)
• OASAS: Deeming Initiative, Outpatient and Opioid Treatment Programs (checked October 7, 2026)
• OASAS: CASAC credential (checked October 7, 2026)
• DEA Diversion Control Division: Dear Registrant letter, January 12, 2023 (checked October 7, 2026)
• CARF: ASAM Level of Care Certification and Find a Provider (checked October 7, 2026)
• ASAM: Level of Care Certification (checked October 7, 2026)
• OASAS: Part 800 General Provisions, §§ 800.4 and 800.6 (checked October 9, 2026)
• 14 NYCRR 818.7 (Justia mirror): Part 818 staffing and 14 NYCRR 810.1: Prior approval (checked October 9, 2026)
• 21 CFR 1308.13(c)(7) and 1301.12 (Cornell LII mirror): Ketamine in Schedule III and Separate registration for each location (checked October 9, 2026)
• NY Public Health Law § 3343-a (public.law mirror of the Senate text): Prescription monitoring program registry (checked October 9, 2026)
• FDA: SPRAVATO prescribing information and Medication Guide, revised 09/2026 (checked October 9, 2026)
• NY Business Corporation Law § 1507: Issuance of shares; State Farm Mut. Auto. Ins. Co. v Mallela, 4 NY3d 313 (2005): opinion (checked October 9, 2026)
• NY Education Law § 6530: Definitions of professional misconduct; 18 U.S.C. § 220 (Cornell LII mirror): Illegal remunerations for referrals (checked October 9, 2026)